Orthogeriatric co-management reduces incidence of delirium in hip fracture patients
Pollmann, Christian Thomas; Neerland, Bjørn Erik; Straume-Næsheim, Truls Martin; Årøen, Asbjørn; Mellingsæter, Marte R.; Watne, Leiv O.
Peer reviewed, Journal article
Published version
Permanent lenke
https://hdl.handle.net/11250/2779884Utgivelsesdato
2021Metadata
Vis full innførselSamlinger
- Artikler / Articles [2092]
- Publikasjoner fra Cristin [1080]
Originalversjon
Osteoporosis International. 2021, Artikkel s00198-021-05974-8. 10.1007/s00198-021-05974-8Sammendrag
Summary: Hip fracture patients often display an acute confusional state (delirium) which is associated with worse outcomes. In this observational study, we found that co-management of hip fracture patients by a multidisciplinary team including a geriatrician and an orthopaedic surgeon could reduce the incidence of delirium.
Introduction: Delirium after hip fracture is common and is associated with negative outcomes. We investigated if orthogeriatric co-management reduced the incidence of delirium in hip fracture patients.
Methods: In this single-centre, prospective observational study, we compared the incidence of delirium and subsyndromal delirium (SSD) before (usual care group, n = 94) and after (orthogeriatric group, n = 103) the introduction of orthogeriatric co-management as an integrated caremodel. The outcomemeasure ‘no delirium/SSD/delirium’ was treated as an ordinal variable and analysed using the chi-squared test and multivariable ordinal logistic regression.
Results: The groups had similar baseline characteristics except for a higher proportion of patients with pre-existing cognitive impairment in the usual care group (51% vs. 37%, p = 0.045). Fewer patients in the orthogeriatric group developed SSD or delirium (no delirium: 59% vs. 40%/SSD: 6% vs. 13%/delirium: 35% vs. 47%; p = 0.021). The number needed to treat (NNT) to avoid one case of SSD or deliriumwas 5.3 (95%CI: 3.1 to 19.7). In a multivariable analysis adjusted for age, sex, ASA class, preexisting cognitive impairment, time to surgery, type of surgery, and medical or surgical complications, the odds ratio for the development of SSD/delirium was lower in the orthogeriatric group (OR = 0.46, 95% CI: 0.23–0.89, p = 0.023).
Conclusion: Orthogeriatric co-management as an integrated care model reduced the incidence of SSD/delirium in hip fracture patients.
Beskrivelse
This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.